Privacy and Client Record Inquiry

Access to Health Information

You have the right to view and/or request access to your personal health information. Please contact QuickStart Early Years over the phone at 1 844 515-1919. Please note, we require a written request that is signed by the patient (if 12 years of age or older) or the parent/legal guardian before the request can be fulfilled.

If you wish to fill out a request form, please click here

"*" indicates required fields

Requester Information

Relationship to Patient
(if applicable)

Patient Information

MM slash DD slash YYYY
Consent*
Clear Signature
MM slash DD slash YYYY

Request a correction of Health Information

You have the right to request a correction of your personal health information. Please contact QuickStart Early Years over the phone at 1 844 515-1919. Please note, we require a written request that is signed by the patient (if 12 years of age or older) or the parent/legal guardian before the request can be fulfilled.

If you wish to fill out a request form, please click here

"*" indicates required fields

Requester Information

Relationship to Patient
(if applicable)

Patient Information

MM slash DD slash YYYY
Please describe the information you believe is inaccurate or incomplete, and explain the correction you are requesting
(if any)
Drop files here or
Max. file size: 20 MB.
    Consent*
    Clear Signature
    MM slash DD slash YYYY

    Privacy Complaints

    If anyone believes that the Agency has mishandled Personal Health Information (PHI), they have the right to file a privacy complaint.

    Complete a Complaint form here

    Contact the Privacy Commissioner of Ontario

    You can contact the Privacy Commissioner of Ontario if you think QuickStart Early Years has violated your privacy rights. You can reach them at:

    2 Bloor Street East, Suite 1400, Toronto, Ontario, M4W 1A8.

    Tel: 1-800-387-0073
    Email
    Website

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